Preventing inappropriate denials by insurers for medically necessary services
The implementation of HB 1087 could significantly reform the claims process between health care providers and insurers. It prohibits the denial of claims solely on the basis of administrative or technical issues, unless the insurer has credible evidence of fraud. Furthermore, the bill sets strict timelines for recouping previous payments, which could protect providers and patients from unexpected charges and enhance the overall transparency of insurance claim practices. By doing so, it aims to foster a more supportive environment for both patients and medical providers navigating health care services.
House Bill 1087, introduced by Representative Kate Lipper-Garabedian, seeks to protect patients from inappropriate denials by health insurance carriers for medically necessary services. The bill establishes that health insurance providers are mandated to pay for services ordered by the treating healthcare provider if they qualify as covered benefits under the insured’s health plan and the services align with the carrier's clinical criteria. This measure aims to enhance patient access to necessary care and reduce administrative hurdles that often lead to delays or denials of important health services.
Discussion surrounding HB 1087 highlights potential contention points, particularly regarding the balance of authority between insurers and healthcare providers. Advocates for this bill argue that it addresses long-standing issues of unfair insurance practices that delay patient care. However, some insurance advocates express concerns that these provisions may hinder the ability of insurers to effectively manage risks and costs. They argue that the bill could lead to an increase in claims with less scrutiny, resulting in higher healthcare costs overall. Thus, while the bill aims to enhance patient rights, it raises questions about maintaining cost-effectiveness in health care provision.